Gender differences in cumulative life-course socioeconomic position and social mobility in relation to new onset diabetes in adults-the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)

Abstract

Purpose: We investigated gender-specific associations of cumulative socioeconomic position across life course and social mobility with new onset diabetes mellitus (NODM) in over 12,000 civil servants in Brazil.

Methods: We used data from ELSA-Brasil baseline (2008-2010). The accumulation of risk was assessed using an education-based score and an occupation-based score. Educational and occupational social mobility were also evaluated.

Results: In minimally adjusted models, NODM increased with increasing exposure to life-course social disadvantages, especially in men. This gender difference was pronounced when cumulative processes were evaluated by education-based scores (high vs. low cumulative social disadvantage, odds ratio [OR] = 4.7; 95% confidence interval [CI]: 2.6-8.5 in men and OR = 2.0; 95% CI: 1.1-3.6 in women). After including proximal diabetes risk factors possibly acting as mediators, these associations remained high only in men (high vs. low cumulative social disadvantage, OR = 4.4; 95% CI: 2.4-8.1). Social mobility was associated with NODM in men. Compared to the high-stable trajectory, downward had greater associations than upward mobility. In women, when considering metabolic syndrome-related variables, changes in social hierarchy did not seem to have an influence on their risk of diabetes.

Conclusions: Accumulation of risk and social mobility were associated with NODM with gender-specific patterns, suggesting differences in mechanisms connecting life-course socioeconomic position and diabetes in men and women.

Keywords: Diabetes; Health inequalities; Life-course epidemiology; Social mobility.